Politicians', bureaucrats' drug plans deemed too costly for public formularies

Call a spade a spade, says Lillian Morgenthau, president of Canada's Association for the Fifty Plus (CARP).

Politicians and bureaucrats whose taxpayer-funded drug plans include medications that they've deemed too expensive for the formularies of public plans for seniors, Aboriginals, veterans and soldiers are being nothing short of “hypocritical,” Morgenthau told CMAJ.

A study conducted for CARP, a non-profit advocacy group, by consultants Wyatt Health Management, a for-profit provider of consulting services in market access and reimbursement, found that public drug plans for federal, Ontario and BC politicians and civil servants was far more expansive than other public plans administered by governments.

“It's unbelievable,” says Morgenthau. “There's no necessity for this double standard, especially when we're paying for it. If it's too costly to include us, then it's too costly to include them.”

Wyatt assessed the status of the 73 drugs that have been approved by Health Canada and submitted to the Common Drug Review, an independent, intergovernmental body that recommends whether a medication should be included in federal and provincial formularies (except in Quebec).

With the exception of 2 drugs that manufacturers haven't yet made available in Canada, 71 of the 73 drugs were automatically included in benefit plans of politicians and civil servants the moment they received Health Canada approval for sale in Canada.

The Common Drug Review, which assesses the cost-effectiveness of new drugs, recommended that 28 of the 73 be made available in the non-political plans. All but 1 (which isn't yet sold in Canada) are in the veteran's plan but only 20 are in the soldier's plans, while only 15 are reimbursed by the Ontario, BC and federal Aboriginal drug benefits plans.

Of the 26 drugs the Common Drug Review recommended not be listed, 1 is unavailable for sale, and 3 are included in the soldiers and Aboriginals plans. The BC plan covers 2 and Ontario 1. The remaining 19 drugs in the list of 73 are still under CDR review.

Wyatt Health Management founder and managing director George Wyatt argues it's disingenuous for administrators to say the discrepancies are incidental because an individual can seek “special authorization” to have a drug covered. “Those mechanisms can be onerous and it depends on the motivation of the physician,” Wyatt says. “Sometimes it depends on the physician's writing skills. The people in the public sector don't have to exactly go through the same hoops.”

It's also inefficient, Wyatt adds. “We have a physician shortage in this country and physicians only have so many hours. If they have to spend more time on administration, it's not a good use of resources.”